Cardiovascular Outcomes Using Intra-Aortic Balloon Pump in High-Risk Acute Myocardial Infarction With or Without Cardiogenic Shock

Bahekar, Amol; Singh, Mukesh; Singh, Sarabjeet; Bhuriya, Rohit; Kazemi, Ahmad; Khosla, Sandeep; Arora, Rohit

doi:10.1177/1074248410395019

Cited by 73 publications

(48 citation statements)

References 48 publications

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“…A meta-analysis of IABP use in patients with AMI showed no effect on outcome; however, in the subset of AMI and CS, there was significantly decreased in-hospital mortality with IABP compared with no IABP. 34 The Cochrane analysis conducted in 2010 generated similar results-the efficacy and safety of IABP versus standard therapy or LV assist device in AMI complicated by CS was examined-no evidence for survival benefit was seen with IABP with heterogeneous effects on hemodynamics and device-related complications (Figure 3). 35 The IABP-SHOCK Trial was a prospective randomized control trial evaluating clinical outcome in 45 patients with post-MI CS treated with primary PCI with or without IABP support.…”

Section: Post-mi and Cardiogenic Shockmentioning

confidence: 62%

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Intra-Aortic Balloon Pump for High-Risk Percutaneous Coronary Intervention

Patterson

Perera

Redwood

2014

Circ: Cardiovascular Interventions

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Interestingly, the International Benchmark Registry (250 US and non-US centers) of over 20 000 patients treated with IABP suggested that 1 in 5 cases of IABP implantation were for CS and 1 in 5 as an adjunct to high-risk PCI. 11 In the context of AMI, IABP was used more frequently during CS (30%) or an adjunct to PCI (30%).10 Analysis of the CathPCI Registry from the National Cardiovascular Data Registry of patients who underwent high-risk PCI (10% in CS and 80% ST-segmentelevation myocardial infarction [STEMI]) with and without the use of IABP found IABP use was slightly less-10% of (Circ Cardiovasc Interv. 2014;7:712-720.) © 2014 American Heart Association, Inc. Post-MI and Cardiogenic ShockAMI is complicated by CS in ≈5% to 10% of cases. Although death from AMI has decreased with aggressive primary prevention and after wide-scale institution of early urgent revascularization, the incidence of CS after MI remains unchanged. 25The presence of CS is a major adverse prognostic factor and still the most common cause of hospital mortality (60%-70%) associated with AMI. 26 In addition to revascularization, optimal drug therapy, vasopressor, and inotropic support, IABP is the most commonly used mechanical support device to maintain hemodynamic stability in an attempt to improve clinical outcome. The evidence for the use of IABP as an adjunct to PCI in post-MI CS is controversial. A recent meta-analysis of registry data showed no benefit from the use of IABP in CS with regard to 30-day mortality independent of reperfusion strategy, which led to the recent downgrading of the American Heart Association guidelines on hemodynamic support in post-MI CS from a Class I recommendation to Class IIB. [27][28][29] Early use of IABP in post-MI CS was based predominantly on small nonrandomized retrospective studies. In the thrombolytic era, concomitant IABP in the presence of recombinant-tissue plasminogen activator was thought to enhance thrombolysis through augmentation of perfusion pressure and was associated with a reduction in in-hospital and 1-year mortality when compared with thrombolysis alone. 30,31 In the late 1990s, the multicenter randomized Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial showed a benefit to short-, medium-, and longterm survival incurred by early revascularization post-MI complicated by CS. 32 The Thrombolysis and Counterpulsation to Improve Survival in Myocardial Infarction Complicated by Hypotension and Suspected Cardiogenic Shock (TACTICS) randomized trial of IABP-assisted thrombolysis in post-MI CS did not reach its primary end point of improved 6-month survival, but there was trend to increased survival with IABP in patients with significant heart failure. 33 One interpretation is that thrombolysis is an inferior reperfusion strategy, and this may explain why no benefit has been definitively shown with IABP after primary PCI. A meta-analysis of IABP use in patients with AMI showed no effect on outcome; however, in the subset of AMI and CS, there was si...

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Section: Post-mi and Cardiogenic Shockmentioning

confidence: 62%

“…27,34 In summary, these data do not support routine use of IABP in AMI outside the setting of CS. However, it may be of benefit if there is evidence of impending hemodynamic instability.…”

Section: Circ Cardiovasc Intervmentioning

confidence: 77%

Intra-Aortic Balloon Pump for High-Risk Percutaneous Coronary Intervention

Patterson

Perera

Redwood

2014

Circ: Cardiovascular Interventions

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“…In contrast, Bahekar et al [12] analysed 6 cohorts containing 24,541 patients with IABP and reported a 28 % (p<0.0004) reduction in mortality in those receiving IABP.…”

Section: Ami With Csmentioning

confidence: 81%

“…A centrifugal pump then moves the blood over a membrane oxygenator before injecting it back into the common iliac artery The divergent observations from these large meta-analyses require some explanation. In the meta-analysis by Bahekar et al [12], there was no separation of those receiving thrombolysis and those treated by PCI. The apparent reduction in mortality in patients receiving thrombolysis may be explained by confounding influences and selection bias; patients receiving thrombolysis were younger, more often male and sicker patients deemed 'too ill' may have been excluded.…”

Section: Ami With Csmentioning

confidence: 97%

Use of Left Ventricular Support Devices During Acute Coronary Syndrome and Percutaneous Coronary Intervention

Spiro

Doshi

2014

Curr Cardiol Rep

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In an effort to improve outcomes in percutaneous coronary intervention (PCI), percutaneous ventricular assist devices (PVADs) have been investigated in (1) high-risk PCI, (2) acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) and (3) in AMI without CS. PCI has become an increasing complex due to an ageing population with complex disease and the frequent presence of impaired LV function. Patients undergoing high-risk PCI in these circumstances are prone to acute cardiovascular collapse. Additionally, mortality in AMI complicated by CS remains high. Lastly, LV support during AMI may reduce infarct size and therefore preserve LV function. At present, four commercially available devices exist: intra-aortic balloon pump counterpulsation (IABP), Impella, TandemHeart and extracorporeal membrane oxygenation (ECMO). These devices are employed in an effort to increase cardiac output, mean arterial pressure (MAP) and coronary perfusion and to reduce pulmonary capillary wedge pressure (PCWP). The mechanism of action differs with each device, and there are advantages and disadvantages. In this update, we discuss recent data describing the use of PVADs to support patients with AMI with or without cardiogenic shock and during high-risk PCI. We focus on the unique features of each device, highlighting strengths, weaknesses and frequently encountered complications, which may be important when tailoring the most appropriate PVAD therapy to an individual patient's need.

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“…Peak diastolic pressure is increased and the end-systolic pressure is decreased during continuous inflation-deflation cycles, which results in a reduction of afterload and improved coronary flow. Previously reported as a first line strategy (class I C) [30] with scientific support from the SHOCK Trial Registry [31] and the National Registry of Myocardial Infarction-2 (NRMI-2) [32], IABP lost its position in guidelines due to several meta-analyses [33,34] and IABP-SHOCK II Trial [35] results with no further support of any IABP benefit. Unfortunately, while IABP is not efficient to ensure long-term survival, there is no well defined reason why the improvement in the haemodynamic status after IABP insertion is not a suitable predictor of better survival.…”

Section: Intra-aortic Balloon Pumpmentioning

confidence: 99%

The management of patients with cardiogenic shock

Sadowski¹,

Janion−Sadowska²

2017

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Cardiogenic shock is a life-threatening condition with a very poor prognosis. Many disorders may contribute to the development of shock. Of them, acute myocardial infarction is the main culprit. Despite tremendous progress in the field of interventional cardiology, in-hospital and long-term mortality still exceeds 50%. Data from large controlled trials on cardiogenic shock are scarce due to ethical reasons. Nevertheless, there is a chance for acceptable long-term survival in patients treated aggressively. The aim of this review is to summarise the key points of differential diagnosis and to emphasise that in most cases of shock due to acute myocardial infarction primary coronary intervention is the treatment of choice. StreszczenieWstrząs kardiogenny jest stanem zagrożenia życia o bardzo złym rokowaniu. Wiele sytuacji klinicznych przyczynia się do rozwoju wstrząsu, ale ostry zawał serca stanowi najczęstszą przyczynę. Pomimo olbrzymiego postępu w kardiologii interwencyjnej śmiertelność szpitalna i długoterminowa nadal przekracza 50%. Z powodów etycznych nie dysponujemy danymi z kontrolowanych badań klinicznych. Niemniej agresywne leczenie stwarza szansę na uzyskanie akceptowalnego poziomu śmier-telności w tej grupie chorych. Celem pracy jest próba podsumowania najważniejszych elementów diagnostyki różnicowej oraz wykazanie, że pilna rewaskularyzacja za pomocą angioplastyki wieńcowej jest leczeniem z wyboru w większości przypadków.

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Cardiovascular Outcomes Using Intra-Aortic Balloon Pump in High-Risk Acute Myocardial Infarction With or Without Cardiogenic Shock

Cited by 73 publications

References 48 publications

Intra-Aortic Balloon Pump for High-Risk Percutaneous Coronary Intervention

Intra-Aortic Balloon Pump for High-Risk Percutaneous Coronary Intervention

Use of Left Ventricular Support Devices During Acute Coronary Syndrome and Percutaneous Coronary Intervention

The management of patients with cardiogenic shock

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